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0202-253 (SFD)LICENSED CONTRACTOR DECLARATION I -hereby affirm under penalty of perjury that -I am licensed under -provisions of- _ Chapter 9 (commencing with Section 7000) of Division'3 of the Business and Professionals Code, and my License is in full force and effect. d License # Lic. Class Exv,, Da e Date W/ 7Signature of Contractor fs .S' u ti ✓" OWNER -BUILDER DECLZARATION I hereby affirm under penalty of perjury thatrl am exempt from the Contractor's License Law for the following reason: ( ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). () I am exempt under Section B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: () I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( ) I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. STATF i UND .1601391.01 (This section need not be completed if the permit valuation is for $100.00 or less). ( ) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to; become subject to the Workers' compensation laws of California, a� d�g ,eq',tht, �'fl should become Subject to the workers' compensation p�rov`s�IonsSeetic�n 3700 of the Labor Code, I `sT (If orth ' it •comply with those provisions Date: �7� Applicant_`ft.. a Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Codeinterest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at' whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnity & hold harmless the City of La Quinta, its officers, agents and employees 2. Any permit issued as a result of this application becomes null and void If work is not commenced within 180 days from date of issuance of such • permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize -representatives of this City to enter upon the above-mentioned property for insp'ectipn purposes.- �. �j / Signature (Owner/Agent) i a�'r t""Date '�'��& PERMIT /1 ` = BUILDING PERMIT DATE VALUATION LOTi TRACT 139 JOB SITE ADDRESS APN spy A&WIMES "34M-013 OWNER CONTRACTOR / DESIGNER / EN (NEER CAN,K"i` Ar & COMPANY L',AWWAV & COMPY" '.1USTN - . i'CA ' 92780 fU911a • CA 9 780 i � i1S-44.0 s.- 141, A4 5 USE OF PERMIT tlsSF10 - W141" 1, ��J I�f79.Y.A1��:�i�Stts��yAP-19Iy'':�I�yIXT iDfgy�ip�iM '�II�fCJd't' IJL'fd�;a'�LOCIIy�+� 113�IQ�9°Sft [J1af F1f.A..l ,VS4`I3M".e�4 SPA 5.+.R' .�.lM1"1tl?i�'.5�7"/AY G'•4"G"'1-L,Li l.±�i.4;.H. I` 1A. ��c.�Y"!N �. -Y ic. K �F'4 E REDUCTION DLiP TO MULTIAi % ISSUANCE OF 11,1,MM PLAIN TYPE al`MC:'T CIC 113'PF(.UCTION 3.05AX0 SF 371.fq�}�► OF'' . (POpRCei/�I�l^Yy�/.r��p,`pISt3 /'j¢►' 1d3d4�M13�W7A'.d'itlLyid�F.+Y1T 6310 Y10 S CCW OF �°t)WINUCITO�4' '�yL ,�/yy^^����yy 'x�` xx pyyp� y�Q �'ga�:t':��`i�s'Wrk1> A'..KsY,[Gl`Cl.SJ' F Ni7A8�l:Y.SAR L . , -4 f,ONS1'RLIC' 10 . E 101.000.41C''O Y $023,00 FLAX CHECK nk 101. �000-4894'jlg $1194.W FR�:541.+S1F.l at''i�`IrTA�D P f9»klr It.7l ^•liVV'�•'I��?"f n�� Y ��4�sJeVV VILECTRICAiI,FFF $167.29 taLUMMO FEE 101.000.-419.000 801' ORA1:?I-00 Fgf�t. 101-dTa7(4D;—(S u2frM fl3? VE Ol%RA iMPAC'T FI.',lT I�gffP,OiI �t. liUMo=# 1T%3I, iOs$�A°t RM".:'1fE .115 YLttiiW 0`C:9,326.93 IM TIRL-PAID 1M $©,Glia I('A.y .A•pYly�p g��p� �y 1� tr �r •�,tY 7i hx +tn� t•C _- .. ° ' �.R. aRaS.e...S.?''.'.bS.t�d'SY�� �J�J,s.LutJ' D E'tYOsOS'7 p,n� t►4 AR 2 VZ - c� iD A 0FL"AQdI4TA r , GE ° ``" ATEA"– BY DATE FINAL9D ' / INSPECTOR G INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS Af MECHANICAL APPROVALS Set Backs .ice - Underground Ducts Forms 8 Footings Ducts Slab Grade — pZ, Return Air Steel - Combustion Air Roof Deck -/7- p Exhaust Fans 0. K. to Wrap �(9� F.A.U. Framing - Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath — / _ "-Z Drywall - Int. Lath Final Final (� BLOCKWALL APP OVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines _ Heater Final Water Piping Plumbing Top Out Plumbing Final Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Gas Piping 11=� Encapsulation Gas Test 07— ZAppliances Appliances 66 Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring -7-/ Jr Low Voltage Wiring C� Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final S Utility Notice (Perm) COMMENTS: I Certificate of Occupancy City of La Quinta Building and Safety Department, This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: BUILDING ADDRESS: Use Classification: SINGLE FAMILY DWELLING Occupancy Group: R-3 Type of Construction: VN 47=010 VIA ANTIBES Bldg. Permit No.: 0202-253 Land Use Zone: RL Owner of Building: CANADAY & COMPANY Address: 17-480 E. 17" ST #106 City: TUSTIN, CA 92780 By: STEVE TRAXEL fd�t Date: 10-28-2002 I� Building Official POST IN A CONSPICUOUS PLACE